What is a transoesophageal echocardiogram?
A transoesophageal echocardiogram, often shortened to TOE or TEE, is an ultrasound of the heart taken from inside the gullet rather than from the surface of the chest. Because the gullet lies directly behind the heart, with no ribs or lung tissue in the way, the pictures are far more detailed than those of a standard scan. A thin, flexible tube with a small ultrasound probe at its tip is passed through the mouth into the gullet, in much the same way as a gastroscopy.
Why is it done?
It is used when fine detail matters: to look for a blood clot in the upper chamber of the heart, to search for infection on a heart valve, to assess a leaking or narrowed valve and plan its repair or replacement, to examine an artificial valve, to look for a hole between the chambers or the source of a stroke and to guide certain procedures.
How do I prepare?
Do not eat or drink for at least six hours before the test, so that your stomach is empty; you may take essential medication with a small sip of water as instructed. Because you will be sedated, you must arrange for someone to drive you home, and you should not drive, operate machinery or sign important documents for the rest of the day. The test is sometimes done in the rooms, sometimes in the cardiac care unit (high care) and sometimes in the catheterisation laboratory.
What happens on the day?
A drip is placed and your heart rhythm, blood pressure and oxygen level are monitored. The back of the throat is sprayed with local anaesthetic, which tastes bitter and makes the throat feel numb and swollen. Sedation is then given through the drip so that you become drowsy and remember little of the test. Dentures are removed and a mouthguard is placed between the teeth before the probe is placed inside your gullet.
What to expect afterwards
Because of the sedation you should be accompanied home, rest for the day and not drive. You should not eat or drink before you are fully awake.
Possible complications
This is a very safe test in experienced hands, but it is more invasive than a normal ultrasound. Common and minor: a sore throat, hoarseness, mild nausea or a bruise at the drip site. Uncommon: a lip, tooth or dental crown being damaged and vomiting. Rare but serious: a tear or perforation of the gullet, which occurs in far fewer than one in a thousand cases but may need surgery; significant bleeding; inhaling stomach contents into the lungs or a disturbance of heart rhythm.
This information does not replace a consultation. Please discuss your own risks and options with your cardiologist.